Laparoscopic and endoscopic cooperative surgery: current status and clinical applications

Recent advances have been made in minimally invasive treatments for benign tumors, borderline malignant tumors, and early gastric cancer (EGC). Laparoscopic and endoscopic cooperative surgery (LECS) combines laparoscopic and endoscopic approaches performed simultaneously, thereby maximizing the advantages of each modality while overcoming the individual limitations. Consequently, LECS enables precise tumor localization, complete resection with minimal margins, a reduced recovery time, and improved clinical outcomes. The primary indications for LECS include the resection of gastrointestinal stromal tumors and various benign submucosal tumors, and its application has recently been extended to select EGC cases. In South Korea, the Ministry of Health and Welfare has approved LECS as a new medical technology for gastrointestinal tumors in 2024. Several LECS techniques have been developed, including classical LECS, inverted LECS, laparoscopy-assisted endoscopic full-thickness resection, non-exposed endoscopic wall-inversion surgery, a combination of laparoscopic and endoscopic approaches for neoplasia with a non-exposure technique, and closed LECS. Above all, close cooperation between laparoscopic and endoscopic teams is essential for the successful performance of LECS procedures.